Baseline Characteristics and Mortality Among People in Care for Chronic Viral Hepatitis: The Chronic Hepatitis Cohort Study

Moorman, Anne C.; Gordon, Stuart C.; Rupp, Loralee B; Spradling, Philip R.; Teshale, Eyasu H.; Lü, Mei; Nerenz, David R.; Nakasato, Cynthia; Boscarino, Joseph A.; Henkle, Emily; Oja–Tebbe, Nancy; Xing, Jian; Ward, John W.; Holmberg, Scott D.

doi:10.1093/cid/cis815

Cited by 145 publications

(168 citation statements)

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“…Similarly, we had more than double the subspecialty and disease staging rates cited elsewhere. 17,28 Our results suggest that providing culturally competent, wrap-around patient navigation services was critical for successfully caring for patients with severe mental illness and a history of addiction.…”

Section: Discussionmentioning

confidence: 89%

“…[20][21][22][23][24][25][26][27] Several recent efforts describe and quantify the HCV care continuum. 17,[28][29][30][31][32] Most demonstrate that chronically infected individuals fail to progress through the continuum of care and have low rates of confirmatory testing, as well as barriers to accessing health insurance. 30,33 , 34 Many HCV infections cluster geographically 35 ; distance from health care resources as well as socioeconomic predictors for access to care may influence HCV screening and care.…”

Section: Introductionmentioning

confidence: 99%

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Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

et al. 2015

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BACKGROUND: Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care. OBJECTIVE: We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting. DESIGN: We developed a comprehensive, communitybased HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure. PATIENTS: Philadelphia residents were recruited through street outreach. MAIN MEASURES: We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients. KEY RESULTS: We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8 % of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 % of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment. CONCLUSIONS: Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.KEY WORDS: hepatitis C; HCV screening; community-based screening; patient navigation; continuum of care. J Gen Intern Med 30(7):950-7

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

et al. 2015

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“…In the State of Santa Catarina, HBV genotype D is common. This genotype is also found in Europe, particularly in the Mediterranean region, and it has a high rate of precore mutations 20,31 . This fi nding could refl ect the European immigration profi le in southern Brazil 32 .…”

Section: Characteristics Of Individuals With Positive Serology For Cementioning

confidence: 89%

Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

Nau

Fayad

Lazzarotto

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Introduction: Celiac disease is an autoimmune disorder that involves gluten intolerance and can be triggered by environmental factors including hepatitis B virus (HBV) infection. This study aimed to describe the prevalence of celiac disease in individuals with HBV infection and to describe the clinical and laboratory characteristics of celiac disease associated with HBV. Methods: This cross-sectional study included 50 hepatitis B patients tested for IgA anti-endomysial antibodies (EMAs) and tissue antitransglutaminase (TTG) between August 2011 and September 2012. Results: Fifty patients were included with a mean age of 46.0 ± 12.6 (46.0) years; 46% were female and 13% were HBeAg+. Six patients had positive serology for celiac disease, four were EMA+, and fi ve were TTG+. When individuals with positive serology for celiac disease were compared to those with negative serology, they demonstrated a higher prevalence of abdominal pain (100% vs. 33.3%, p = 0.008), lower median creatinine (0.7mg/dL vs. 0.9mg/dL, p = 0.007) and lower mean albumin (3.6 ± 0.4g/L vs. 3.9 ± 0.3g/L, p = 0.022). All individuals with positive serology for celiac disease underwent upper digestive endoscopy, and three of the patients exhibited a macroscopic pattern suggestive of celiac disease. Histologically, fi ve patients demonstrated an intra-epithelial lymphocytic infi ltrate level > 30%, and four patients showed villous atrophy associated with crypt hyperplasia on duodenal biopsy. Conclusions: An increased prevalence of celiac disease was observed among hepatitis B patients. These patients were symptomatic and had signifi cant laboratory abnormalities. These results indicate that active screening for celiac disease among HBV-infected adults is warranted.

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“…CHeCS is a "dynamic" observational study conducted at 4 large, integrated healthcare systems located in the United States, and represents a geographically, ethnically, and clinically diverse cohort of patients with chronic hepatitis B and C [14]. The data collected are solely based on routine clinical care and thus representative of the uncontrolled healthcare environment of the real-world clinical setting.…”

Section: Data Sourcementioning

confidence: 99%

“…The data collected are solely based on routine clinical care and thus representative of the uncontrolled healthcare environment of the real-world clinical setting. Criteria for inclusion and composition of the CHeCS cohort have been summarized in a previous report [14]. In brief, the CHeCS cohort was created based on analysis of electronic health records (EHR) and administrative data of >2.7 million patients aged 18 years or older who had a clinical service (ie, outpatient or inpatient, emergency department, or laboratory test) provided between 1 January 2006 and 31 December 2012 at 1 of 4 sites: Geisinger Health System in Danville, Pennsylvania, which serves approximately 2.6 million Pennsylvania residents; Henry Ford Health System in Detroit, Michigan, which serves >1 million southeastern Michigan residents; Kaiser Permanente Northwest in Portland, Oregon, which serves approximately 500 000 members; and Kaiser Permanente of Honolulu, Hawaii, which serves about 220 000 persons or approximately one-sixth of Hawaii residents.…”

Section: Data Sourcementioning

confidence: 99%

All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus

Xu¹,

Moorman²,

Tong³

et al. 2015

Clin Infect Dis.

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Background. A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment.Methods. This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation.Results. Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma.Conclusions. The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease.

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Baseline Characteristics and Mortality Among People in Care for Chronic Viral Hepatitis: The Chronic Hepatitis Cohort Study

Abstract: Baseline demographic, hospitalization, and mortality data from CHeCS highlight the substantial US health burden from chronic viral hepatitis, particularly among persons born during 1945-1964.

Cited by 145 publications

References 10 publications

Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

Results from a Geographically Focused, Community-Based HCV Screening, Linkage-to-Care and Patient Navigation Program

Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus

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